Provider Demographics
NPI:1215026836
Name:SMIRES, DANIEL MARK (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARK
Last Name:SMIRES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3173
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-0173
Mailing Address - Country:US
Mailing Address - Phone:609-454-3748
Mailing Address - Fax:
Practice Address - Street 1:5 PLAINSBORO RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536
Practice Address - Country:US
Practice Address - Phone:609-454-3748
Practice Address - Fax:609-454-3764
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00723100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00723100OtherLICENSE